title: Growth of kidney-transplanted pediatric patients treated with sirolimus.
abstract: Experimental findings indicate that sirolimus (SRL) inhibits longitudinal growth by mechanisms potentially related to its inhibitory effects on both cell proliferation and expression of vascular endothelial growth factor (VEGF). The aim of this study was to investigate the growth pattern of kidney-transplanted children treated with SRL in a multicenter observational clinical study. Height, change in height SD (Δ height) and growth velocity of pediatric patients with renal transplant were calculated at 0, 6, 12, and 24 months after starting SRL. Controls of kidney-transplanted children not treated with SRL were matched by age, gender, renal function, and dose of corticosteroids. Sixty-eight children (34 SRL, 34 controls) were enrolled in the study. Nephrotoxicity was the most frequent indication to start therapy with SRL. SRL exerted an adverse effect on growth as demonstrated by significantly lower (p < 0.05) growth velocity (cm/year) and smaller change in height SD in the SRL group after 6 (4.08 vs. 6.56 and -0.05 vs. 0.14), 12 (4.44 vs. 6.11 and -0.03 vs. 0.28) and 24 (4.53 vs. 6.03 and -0.04 vs. 0.53) months of treatment. This study suggests that SRL therapy may interfere with growth of kidney-transplanted children. This undesirable effect needs to be taken into account when considering a switch to SRL and confirmed in further prospective trials including larger number of patients.
authors.affiliation: Hospital Universitario Central de Asturias, Villamil s/n, 33006, Oviedo, Asturias, Spain.
authors.forename: David
authors.initials: D
authors.lastname: González
authors.forename: Clotilde D
authors.initials: CD
authors.lastname: García
authors.forename: Marta
authors.initials: M
authors.lastname: Azócar
authors.forename: Simon
authors.initials: S
authors.lastname: Waller
authors.forename: Angel
authors.initials: A
authors.lastname: Alonso
authors.forename: Gema
authors.initials: G
authors.lastname: Ariceta
authors.forename: Natalia
authors.initials: N
authors.lastname: Mejía
authors.forename: Fernando
authors.initials: F
authors.lastname: Santos
mesh_terms: D002648:Child; D005260:Female; D006084:Graft Rejection / Q000276:immunology / Q000517:prevention & control*; D006130:Growth Disorders / Q000139:chemically induced* / Q000473:pathology; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D016030:Kidney Transplantation / Q000276:immunology*; D008297:Male; D051437:Renal Insufficiency / Q000276:immunology / Q000601:surgery*; D012189:Retrospective Studies; D020123:Sirolimus / Q000627:therapeutic use*; D014184:Transplantation, Homologous
chemical_list: D007166:Immunosuppressive Agents; D020123:Sirolimus